Learn about Breast Reduction Surgery.
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Hello! My name's Adrian Richards and today, I'm going to be talking about breast reduction surgery. Now, this is a very fulfilling type of surgery because people with their very large breasts often have a number of problems due to the weight of the breasts. These can vary from poor posture, difficulty in getting clothes, neck ache, often they have very heavy grooves where the bra digs in. They can also get inflammation, impetigo it's called a skin inflammation, in the fold underneath the breast where the two skin sides are running together. So breast reduction is very satisfying, patients feel a lot better after the operation. Many patients I see do consider it probably the best thing they ever did because they don't realize they are carrying almost these two bags of sugar around in front of their chest all the time and they can't believe the increased movement and the improvement in posture following the operation. So breast reduction surgery, very satisfying. There are different approaches to it. Basically, the approaches are to do with the pattern of skin excision and the way the nipple is kept connected. So the old fashioned way of maintaining blood supply to the nipple was actually to remove the nipple and replace it as a skin graft and that's a technique known as free nipple grafting. Now, that isn't done very often nowadays and the reason for that is the nipple doesn't look very aesthetic afterwards and you lose sensation and the ability to breastfeed following the operation. So free nipple grafting now is an older historical technique and nowadays is only really used for people with very, very big breasts, say a reduction of over two kilograms per side. Nowadays we tend to preserve nipple blood supply and where we can, nipple sensation and we do this by keeping the nipple attached by a bridge of tissue to the underlying chest wall and essentially, the bridge of tissue can have a lot of different patterns but is usually either inferior based, that means it's a bridge running from the bottom or my preferred technique is a superomedial pedicle which is based this way, facing inwards. The reason for that is you maintain volume in the upper part of the breast, and give a better shape and also preserve sensation better to the nipple. So it's worthwhile talking to your surgeon about the type of nipple pedicle, the bridge of breast tissue preserving the blood supply and nerves is called the pedicle. It's worthwhile just having a little bit of information, a little bit of knowledge about the different types of pedicle. The second thing you need to think about is the pattern of skin excision and breast reduction surgery; it always involves a scar around the nipple at the juncture of the brown area, the areola of the nipple and the surrounding skin. So often, patients with big breasts will have big areolas and the areola is usually reduced during surgery. So there'll always be a scar around the junction of the areola, there will always be a scar downwards to the inframammary fold and if you're having a vertical pattern breast reduction, that's the limit of the scarring. Some surgeons will do a more traditional anchor type breast reduction where you have a lollipop incision around the nipple downwards and then along the fold and that's normally used for people with a bigger bust and a bigger reduction. So essentially, how do you choose the type of surgery; know a little bit about the pedicle, probably veer away from anyone who's suggesting free nipple graft unless you're very large busted. Ask about the pedicles, ask about the likelihood of nipple sensation being maintained, ask about the scarring, ask to see some photographs of patients the surgeon has treated previously for breast reduction and where possible, ask the surgeon if you can talk to some of his previous patients. The other important thing to say is that if you are having the surgery, if you're over 40, it's probably best to have a mammogram prior to surgery and
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